“全球疫情会诊室”：中国专家与巴西同行分享抗疫经验

5月20日，中央广播电视总台中国国际电视台（CGTN）的“全球疫情会诊室”节目举办中国-巴西专场，邀请北京大学人民医院援鄂医疗队的专家通过视频会议的方式与来自巴西的同行分享新冠肺炎治疗经验。

根据巴西卫生部的数据，截至当日，巴西累计新冠肺炎确诊病例超过29万，仅次于美国和俄罗斯，为全球第三高；死亡人数超过18000，位于全球第六。据法新社报道，巴西疫情仍处于迅速恶化中，预计6 月初以前都不会到达高峰。

在武汉疫情最严重的时期，北京大学人民医院共派出了134名医护人员到武汉。这支多学科医疗队接管了武汉同济医院中法新城院区的一个重症病房，救治了大量的病人，团队救治成功率达到了96%。

中国驻里约热内卢总领事李杨先生也参加了这场交流，他在开场致辞中表示，当前全球疫情形势仍然严峻，还在朝着最坏的方向发展。面对这样困难的局面，各国除了携手并进、共同抗击疫情之外别无选择，这次视频交流就是各国协力合作的一种表现。通过共同努力，人类终将战胜新冠病毒。

As the coronavirus pandemic continues to wreak havoc around the globe, Brazil is seeing an overwhelming spike as the country reported over 291,500 confirmed  COVID-19 cases as of Thursday, overtaking the UK to become the third-most in global infections.

In the latest episode of CGTN's "COVID-19 Frontline" livestream, which was held on Wednesday, May 20, CGTN invited three veteran experts from Peking University People's Hospital who specialize in pulmonary and critical care medicine, infectious disease, and intensive care medicine, to exchange treatment experience with Brazilian peers.

Li Yang, consul general of the Chinese Consulate-General in Rio de Janeiro, also joined the online meeting and sent his greetings through the program. "Stay together, work together, hand in hand, to fight against this deadly virus, and I believe this video conference is part of our joint efforts. We firmly believe that eventually we will defeat this common enemy of the entire mankind," he said.

如何治疗有心脏并发症的病人？

巴西里约热内卢圣玛丽塔诺医院（Hospital Samaritano）的新冠肺炎项目总负责人、ICU主任里卡多·利马（Ricardo Lima）说，他们在巴西看到很多新冠肺炎病人有心脏并发症，他想了解中国专家对这类病人的治疗经验。

北京大学人民医院呼吸与危重症医学科主任医师曹照龙介绍，根据临床经验和相关文献报告，新冠肺炎主要是伤及的器官是肺，其次就是心脏，重症病人心脏损伤的发生率为12%到23%，出现心脏损伤的病人死亡率很高。

重症医学科副主任朱凤雪说，导致病人心脏损伤的诱因可能有很多种，可能是新冠病毒与ACE受体结合造成的直接损害，也可能是炎症反应或药物造成的损伤。目前没有特殊的治疗手段，重点是辨别和去除诱因，不要加重对心脏的损害，防止病人出现心功能衰竭的征象。还有一部分新冠肺炎患者心肌梗塞的发生率比较高，这部分病人需要加强抗凝治疗。

Treatment for COVID-19 patients with cardio-cerebrovascular complications

Ricardo Lima, chief of the Intensive Care Unit and head of the COVID-19 Project at Hospital Samaritano, said he had seen many cardio-cerebrovascular complications in Brazilian COVID-19 patients, so he would like to know the treatment experience of Chinese doctors.

Zhu Fengxue, deputy director of Department of Critical Care Medicine, Peking University People's Hospital, said the mechanics behind these heart injuries are not clear currently, but it might be related to ACE2 (angiotensin-converting enzyme 2) receptors. It also might be triggered by an inflammatory response or drugs. For this group of patients, the alleviated level of myocardial enzymes can be noticed. In terms of clinical therapies, there is no particular treatment for this kind of complication. Doctors can only try to eliminate the triggers by not aggravating the damage to the heart. 

There is no special therapy. The mortality rate in this group of patients is very high.

中国、巴西医学专家在节目中交流新冠肺炎防治经验

什么情况下病人需要抗凝治疗？

圣玛丽塔诺医院副院长瓦莱里娅·塞勒斯(Valeria Salles)想了解中国同行在什么情况下会给病人用肝素这样的抗凝血剂来预防和治疗血栓。

朱医生介绍了她们采取抗凝治疗的两种情况：一是对有血栓高危因素以及诊断出有血栓的患者，通常是65岁以上，有高血压、糖尿病、冠心病、恶性肿瘤等慢性基础疾病的患者；二是全身小微血管有炎症以及广泛微血栓形成的患者。她解释道，第二种情况是由于新冠病毒会引起大量促炎细胞因子的释放，进而导致微血管的系统受损和异常凝血系统的激活。这种情况下，通常使用普通肝素及低分子肝素来抗凝，使用的剂量要根据患者的基础病情以及凝血功能进行调整。

抗生素是否可以用来治疗新冠肺炎？

塞勒斯医生还想知道中国同行在治疗新冠肺炎患者时是否会用到抗生素，对轻症和重症病人分别如何使用。

曹医生介绍，他们在治疗轻型和普通型病人时一般不使用抗生素，主要采取对症治疗和支持性治疗。对于ICU里需要插管的重症病人，他们会采取一些预防性抗生素治疗，一般用的比较多的是呼吸喹诺酮，包括左氧氟沙星、莫西沙星、二代头孢、三代头孢、碳青霉烯等。但是总的来说，新冠肺炎是一种病毒性肺炎，病人出现细菌性感染的几率不大，所以大多数时候都不用抗生素。

Use of antibiotics

Valeria Salles also asked about the use of antibiotics at different stages.

Dr. Cao Zhaolong said, at present, COVID-19 patients with mild symptoms don't receive antibiotics. But for severe cases, they need to get prophylactic antibiotics. The most commonly used antibiotics to treat severe COVID-19 patients include levofloxacin, moxifloxacin, second generation cephalosporin and third generation cephalosporin. Carbapenem can be used to treat ICU patients. 

主持人焦旸在“全球疫情会诊室”北京演播室

什么情况下对病人用ECMO（“人工肺”）治疗？

圣保罗大学医学院教授路易斯·马尔伯伊松（Luiz Malbouisson）是一名重症医学专家，他询问中国同事在治疗重症病人时是否用到了ECMO，什么情况下应该对病人使用ECMO。ECMO俗称“人工肺”，是一种医疗急救设备，用于对重症心肺功能衰竭者提供持续的体外呼吸与循环，以维持患者生命。

朱医生回答说，ECMO对于新冠肺炎重症患者是一个抢救性措施，一般在病人使用了机械通气以后效果仍然不好、出现重度缺氧的情况下使用。通常做出这一判断有以下几个指标：一是氧合指数持续低于100 mmHg，二是吸气平台压大于35 cmH2O，三是二氧化碳的蓄积导致血液PH值低于7.2。在这种情况下，建议对病人使用ECMO进行治疗。但是在临床上根据病人的实际情况，这些指标也可以适当放宽。比如如果看到病人病情持续恶化，这个时候即使他（她）的氧合指数低于150 mmHg，也可以考虑积极地用ECMO。

她还指出，对病人使用ECMO也会带来各种各样的问题，比如导管内感染、出血等。但是总的来说，ECMO在这次新冠肺炎治疗中的效果还是不错的，一些病情非常严重的病人经过治疗后存活下来。

The use of ECMO

Luiz Malbouisson, professor of Anesthesiology at the University of Sao Paulo Medical School, asked about the use of ECMO (Extracorporeal membrane oxygenation) and when to use it?

Zhu Fengxue said when intubation is not working efficiently on severe patients, the ECMO will be applied. Such as when the oxygen index is lower than 100 and plateau pressures are greater than 35 cm H2O. But if the patient's condition deteriorates dramatically, ECMO will still be applied.

Although ECMO has all sorts of problems, such as catheter-related infections and bleeding problems, overall, in the treatment of COVID-19, ECMO treatment shows a good result. Some severe patients, who got treated with ECMO, have survived.

病人出院后如何做好后续康复？

塞勒斯医生说，在巴西，很多出院的病人仍然需要很长一段时间来恢复肺部功能，她想了解中国是否遇到这种情况，有哪些经验可以分享。

曹医生介绍，根据他们的临床观察，80%左右的新冠肺炎病人都是轻症患者，他们的呼吸功能没有受到太大影响，经过治疗，肺部CT复查显示病灶基本都已经恢复了，没有呼吸方面的后遗症，出院之后可以正常活动。但是对于20%左右的重症和危重症病人，他们除了肺部损伤之外，还伴有心脏、肾脏、凝血系统等多器官的损伤。建议这些病人在出院后三到六个月之内尽量少活动，尤其要避免剧烈运动，否则可能会因为心肌后遗症等有猝死的风险。另外，医生也会给病人一些肺部康复方面的指导。他还建议这类病人去专门的康复医院做恢复治疗。

在时长近一个半小时的节目中，巴西医生还询问了炎症治疗、氧疗等在临床上遇到的一系列具体问题，中国专家们都结合自己的一线经验做了专业的分享和交流，希望用中国经验助力巴西人民战胜疫情。

Potential effects of COVID-19 on the health of recovered patients 

Valeria Salles, chief of International Office of Hospital Samaritano, Brazil, asked about the potential lung damage of recovered COVID-19 patients.

Cao Zhaolong, head physician of Department of Pulmonology and Critical Care Medicine, Peking University People's Hospital, said that according to his treatment experience, 80 percent of COVID-19 patients have mild symptoms, they can do some exercises in the hospital and their respiratory systems are not affected much by the virus.  After these patients are discharged from the hospital, they can live just like a healthy person. But for critical patients, they are not suggested to do much exercises after being discharged. Because the virus has not only damaged their lungs, but has also damaged their hearts, kidneys and coagulation system, they are suggested to not exercise for at least three to six months. The strenuous exercise may cause sudden cardiac death. 

In later episodes of "COVID-19 Frontline," more frontline doctors and experts from Wuhan will join in to share their experience with their colleagues from other parts of the world. If you have any questions regarding COVID-19, you can share it with us using #MyOpinionOnCOVID19 on Facebook.

推荐阅读：